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Inspection on 25/09/09 for Brookfield Christian Care Home

Also see our care home review for Brookfield Christian Care Home for more information

This is the latest available inspection report for this service, carried out on 25th September 2009.

CQC found this care home to be providing an Good service.

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

"Look after residents." "The home always looks neat and clean." Comments made about the staff: "They are all very nice and pleasant and do a good job and they seem to have good patience." "Staff are very helpful and do take notice of what you are saying." The people who use the service can expect; That their needs will be assessed thoroughly, and the necessary care and support they require will be provided when they come to live in the home. That their concerns will be listened to and that they will be protected from possible abuse or harm by the systems in place. A pleasant modern comfortable environment that is able to accommodate their need`s and has the necessary equipment to do so. Staff are friendly and supportive and some have had the necessary training to care for people with diminishing mental health. The service is managed well and in the best interests of the people living there.

What has improved since the last inspection?

The records for the care planning and delivery of support have improved with staff noting better detail about the daily outcomes for people they care for. The record keeping for routine medication using the MAR(Medication Administration Record) administration documents have improved ensuring they are provided safely.

What the care home could do better:

They should ensure that the care planning is holistic to cover all aspects of individual`s lives. Care should be taken to make sure that care planning documents match what individuals support needs are and give staff information about how they wish to conduct their daily lives. The individual`s medication and any specific administration instructions should be clearly identified in their care plan. They should continue with developing the activities provided to meet personal choices and interests. Better care should be taken with the employment practices to ensure that sufficient information is obtained and kept to support that staff are suitable to work in the home.

Key inspection report Care homes for older people Name: Address: Brookfield Christian Care Home Little Bury Oxford OX4 7UY     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Ruth Lough     Date: 2 5 0 9 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 30 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 30 Information about the care home Name of care home: Address: Brookfield Christian Care Home Little Bury Oxford OX4 7UY 01865779888 01865779444 brookfield@schealthcare.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Trinity Care (Brookfield) Ltd care home 66 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia mental disorder, excluding learning disability or dementia old age, not falling within any other category Additional conditions: The maximum number of service users who can be accommodated is: 66 The registered person may provide the following category/ies of service only: Care home with nursing - N to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category - OP Dementia - DE Mental Disorder, excluding learning disability or dementia - MD Date of last inspection Brief description of the care home Brookfield Christian Care Home is a purpose built home situated on the outskirts of the Greater Leys area of Oxford, overlooking open countryside. The home is registered to provide care for up to 66 residents aged 60 and over. Accommodation is provided on two floors. There are spacious lounges and dining rooms on both floors and all bedrooms are single with en-suite facilities consisting of a washbasin and toilet. There is a small garden surrounded by fencing leading from one of the ground floor lounges. Care Homes for Older People Page 4 of 30 2 9 1 0 2 0 0 8 66 66 0 Over 65 0 0 66 Brief description of the care home Ample parking is available at the front and side of the home. The range of fees for this home is £524.00 to £848.00, per week. There are additional charges for hairdressing, chiropody, newspapers, toiletries and physiotherapy. Care Homes for Older People Page 5 of 30 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: This was an unannounced key inspection process generated from the adequate findings identified at the last assessment of the quality of the service by the commission in October 2008. This inspection process included reviewing information provided by the service in the Annual Quality Assurance Assessment and any returned surveys to the commission before a one-day visit to the home. An annual quality assurance assessment (AQAA) is a self assessment and a dataset that is filled in once a year by all providers whatever their quality rating. It is one of the main ways that we will get information from providers about how they are meeting outcomes for people using their service. The Annual Quality Assurance Assessment from this service was returned within the Care Homes for Older People Page 6 of 30 required timescales and had been completed satisfactorily. The registered manager was present when we visited the service on 25th September 2009, between 10:10 and 18:10. During the day the records for care planning, recruitment, and administration of the service were assessed. Four of the people using the service were involved with the inspection process. We met with approximately seven staff, and a small number of relatives. Two visiting health care professionals also contributed to the assessment of the service. The people who use the service and the staff who provide the support were also consulted about their opinion of what is provided, through surveys. Of the fifteen people who are in receipt of support that we contacted, we received nine responses at the time of writing this report, six staff were also contacted through surveys, of which four responded. Two health care professionals who regularly visit the home were also contacted and responded by surveys. From this visit it was found that a number of requirements and recommendations that were made to improve the service during the last inspection process have been met. There was one area that will need to continue to improve as to protect the people they support and one requirement was made to reflect this which was met before the report was completed. A number of good practice recommendations were given at the time of the inspection and can be found in the body of this report. Care Homes for Older People Page 7 of 30 What the care home does well: What has improved since the last inspection? What they could do better: They should ensure that the care planning is holistic to cover all aspects of individuals lives. Care should be taken to make sure that care planning documents match what individuals support needs are and give staff information about how they wish to conduct their daily lives. The individuals medication and any specific administration instructions should be clearly identified in their care plan. They should continue with developing the activities provided to meet personal choices and interests. Better care should be taken with the employment practices to ensure that sufficient information is obtained and kept to support that staff are suitable to work in the home. Care Homes for Older People Page 8 of 30 If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 9 of 30 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 30 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The people who use the service have their needs assessed before they are offered a place in the home. Evidence: Eight of the people who use the service who returned surveys to the commission confirmed that they had received enough information to decide if the home was the right place for them before they moved in. One stated that they did not. The manager provided information in the Annual Quality Assurance Assessment that there is formal process of pre-admission assessment carried out including inviting prospective residents to visit and where possible offering a trial visit before a final decision is made to stay permanently in the home. An assessment of the individuals needs is carried out by the Registered Manager or a senior member of nursing staff. Additional information is obtained from any health or social care practitioner involved in their care. The home currently use a formal document tool to prompt and record Care Homes for Older People Page 11 of 30 Evidence: the outcomes of this assessment process and from what could be seen in the two sampled records we reviewed, these had been carried out appropriately but depth the of information was restricted by the format of the form used. We were informed that these document tools with the care plan documents were in the process of being reviewed and it was proposed to implement new ones in the near future that will have a greater holistic approach to seeking information about the person concerned. Care Homes for Older People Page 12 of 30 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The people in receipt of support can expect that their personal care and health needs will be met. Evidence: Comments made in the returned surveys indicated that generally the people who are in receipt of personal and nursing care felt that their needs were being met. Comments from relatives also supported this. Two health care professionals who visit the service regularly expressed that overall the care and support provision to residents had improved during the last few months. Other comments were; I am satisfied with care. In regard to what they do well; Look after residents. Care Homes for Older People Page 13 of 30 Evidence: And as to what they could do better; To make sure that a resident is sitting comfortably. Trousers are not twisted, catheter and bag in a non twisting position. Hearing aids inserted correctly and switched on. Not all staff know how to do this. A sample of care plans were reviewed to see what instruction staff are provided with of how they are to meet individuals needs including seeking a supporting them to obtain any medical consultation or treatment they may require. During the last inspection process it could be seen that there were some weak areas in the information in the care planning records for this, with gaps in significant information leaving some residents possibly without the care and support they needed. Also the commission had been provided with information about a concern that arose during the period between inspections about appropriate care provided to one individual. Three of the residents records that were reviewed were for individuals in receipt of nursing care were being supported in the specialist unit caring for people with dementia or mental health needs. A further record for a resident living on the ground floor of the home was also sampled as to assess if there was a consistent approach to care planning and record keeping across the home. The records supported that staff are provided with a variable quality of information as to deliver a planned programme of nursing and personal care. However, of those that were reviewed it was clear that generally that staff are writing better detail from what was seen at the last inspection but there were several areas that they should continue to improve on to ensure that a consistent holistic approach is carried out by all. These were to give a good overall picture of the person receiving support, to ensure individuals primary nursing need is clearly identified in the care planning and for those with mental health needs as to how they achieve with them their daily activities of living. We were informed that the intended new care planning tools should improve how the information is delivered to staff in the future. The information, storage and administration of medications were reviewed to see if safe practices are in place and that the people they care for obtain their treatments as prescribed. A gap in administration and recording medications practices were seen during the last inspection process and we were informed by the Registered Manager that the concerns had been rectified including staff training and a more robust audit programme. This could be seen in the MAR(Medication Administration Record) and training records that were reviewed. Through discussion with visiting health Care Homes for Older People Page 14 of 30 Evidence: professionals and staff in the home it was apparent that one resident occasionally had medications covertly or disguised in food when their mood or mental health status changed. Looking at the persons care and medication records this was not recorded appropriately, neither was the decision to do this clearly identified in transferred information or instruction from the health and medical practitioners leading the persons care and treatment. This observation was passed back immediately to the Registered Manager who initiated actions to rectify concerns. Care Homes for Older People Page 15 of 30 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The people who use the service are given the opportunity to exercise some choice over their lives and be able to maintain their interests. Meals and menu planning meet their health needs and some of their personal choices and support is given when required. Evidence: According to information from the returned surveys from participants the majority indicated that there were activities provided that they could join in with. One stated that there wasnt any activities they could participate with. An additional comment made in regard to what they could improve was, Arrange a few outings, some activities to stimulate residents. Perhaps some conversation occasionally. During the last inspection visit to the service it was found that the record keeping for activities and choices for daily routines was weak but there were signs of a gradual improvement with some staff completing personal history on individuals. The sampled records that were reviewed during this inspection showed that the staff who care for those with a primary need of dementia had completed personal life histories as to Care Homes for Older People Page 16 of 30 Evidence: assist with supporting them. Some of the information although recorded had not be taken into consideration in the care planning records. From discussion with staff on duty they had a far greater understanding of individuals choices for daily routines and their enjoyment of activities provided in the home that is actually recorded in the care records. The home employs two staff to provide activities in the home who are usually available during the week, with one working occasional weekends. Activities vary, the majority appear to be group events that the can join in with such as musical therapy, musical entertainment and handicrafts. An activity with music was observed during the morning of the inspection visit which some of the residents appear to be participating with, others did not seem to be engaged with what was going on. Care should be taken with the selection of music as to be appropriate to personal choices and that it reflects the participating generations experiences. The programme of external events brought into the home was reviewed and mainly consisted of visiting singers and musicians, church services, prayers and assocaited songs. There were mixed responses and comments in the surveys returned to the commission in regard to the meals provided in the home. One professional made an observation as to what they could do better, When staff assist with eating they could tell the person concerned what the meal consists of. A relative stated that the pasta provided did not always suit residents who had difficulty with eating it and didnt particularly enjoy it. They also stated that they never see fresh fruit. The meal and menu planning is carried out using the organisations Nutmeg tool which assists with making the planned diet wholesome and nutritious and balanced across the day. Looking at the 4 weekly rotational meal plan that was provided by the home there is sometimes areas of repetitiveness such as pork and fish as choices twice in one week and beef and turkey as the main courses in another. Fresh fruit is indicated as to being provided mid morning and afternoon should residents wish although this was not observed during the day. The menu does not offer fresh fruit as an alternative to the planned desserts. Staff to whom we spoke to during the day confirmed that finger foods or snacks were made available for residents to have although they were not always appropriate to the Care Homes for Older People Page 17 of 30 Evidence: ability for some residents to manage. Celery and carrot sticks were proving difficult for residents with problems with teeth or dentures and those with swallowing difficulties. Care Homes for Older People Page 18 of 30 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The people who use the service can be confident that their concerns or complaints will be listened to and acted upon. The service has systems in place to protect the people living in the home from possible abuse or harm. Evidence: Staff are very helpful and do take notice of what you are saying. Comments in the returned survey indicate that residents and relatives feel confident to raise concerns and that they will be listened to by staff when they do so. Information that was given in the AQAA states that the home has had 12 complaints made to them with 11 upheld and one still being investigated, since the last inspection process. The commission has not been in receipt of any concerns and complaints during the last 12 months and has been informed of any safeguarding issues and outcomes of investigations as they occur. The records for complaints management were reviewed to see what processes are in place and that there is an effective monitoring of trends of concerns to assist with developing the service. The records reviewed show that the manager is following the organisations complaints procedure correctly, recording information sufficiently and putting the necessary actions in place to rectify the concerns. Additionally they now have placed comment books on each floor to assist with how the manage minor Care Homes for Older People Page 19 of 30 Evidence: concerns if they arise. Staff are provided with the necessary training and information in the home about safeguarding residents from possible abuse or harm. They have access to the core policies and procedures and have been provided with contact details of the local authority if they identify concerns. Staff appear to have a good understanding of their responsibilities and have acted appropriately when incidents have arisen in recent months. From information given by health care professionals the staff have worked well with them during investigations and have put improved practices in place to ensure the safety and well being of residents is maintained. One safeguarding referral and investigation carried out since the last inspection process resulted in a member of staff put on the POVA list. Care Homes for Older People Page 20 of 30 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is maintained well and meets the needs of the people who live there. Evidence: A visiting professional stated, The home always looks neat and clean. The home is purpose built and can offer residents single en suite accommodation over two floors. It also provides plenty of communal spaces across the building for residents to use, with the main lounges and dining areas being comfortably furnished and offering good space for people to participate in groupg activities going on. The home has four smaller rooms available to use for private and small group activities and although identified at the last inspection process as impersonal and not homely very little has been done to improve these. The previous concerns identified in the last inspection visit about the quality of the food serving areas on each floor have been partially improved and we were informed that work surfaces in these areas were being planned to be replaced in the near future. All the kitchen areas on each floor looked tidy and well kept which is an improvement to what had been observed at the last inspection process. Throughout the home it appears to be kept to a good standard of cleanliness and the programme of redecoration and refurbishment continues to make the environment Care Homes for Older People Page 21 of 30 Evidence: pleasant for the people who live there. The Registered Manager provided information in the AQAA that they have a Check it electronic monitoring tool that aids the organisation to oversee the general audit of the environment. This is a relatively new tool and appears to be used effectively. Additional information given states that they have acquired 41 new profile beds for the home which will assist with how staff care for people and make individuals feel safe and secure and less risk to them falling. Care Homes for Older People Page 22 of 30 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The deficit in the permanent staff employed in the home has not significantly affected their ability to meet the needs of the people they support. Evidence: Staff are very helpful. One relative stated that the nursing and care staff were flexible to changes in her husbands mood and added, They are all very nice and pleasant and do a good job and they seem to have good patience. One professional fed back information they have received, Relatives that I have spoken to have been very complimentary about particular care staff, they are very helpful and communicate well. To the question in the surveys sent out be the commission, Are staff available when you need them? The majority of the people who responded thought that they were. An additional comment was made by one, Although it is sometimes short staffed as a result of sickness and holidays. I have always found staff are courteous and well mannered. I must praise them for all their efforts. To what they could do better one professional put, Think about smaller details such Care Homes for Older People Page 23 of 30 Evidence: as when transferring people from a wheelchair staff do not seem to explain what they are about to do. A relative also put about what they could improve, I would like that the nurses and staff would leave everything in easy reach, such as the TV remote and magazines. Sometimes they are left on a chair on the other side of the room. Another comment was, Often short of staff. Information in the AQAA showed was that there were some staffing issues in the home and a number of shifts were being covered by agency while a recruitment drive carried out. Since the last inspection process 15 staff have left the service leaving a deficit in nursing, care and the management provision of the home. At the time of the inspection visit, this appears to be resolving, with new staff recently employed and some returning from maternity leave. A sample of 4 weeks duty rotas were reviewed which supported that the management of the home has ensured that the staffing levels are maintained. We looked at the recruitment, employment and training information for 3 staff employed in the home to see if the processes are carried out effectively and that residents are supported by suitable staff. The records showed that they are obtaining the required information and carry out the necessary checks before a new member of staff commences working in the home. However, for one person there were some gaps in work history that had not been explored thoroughly and improvements could be made in using the employment checklist more effectively. Information about the qualifications and training that staff have achieved indicated that they have below 50 of the care staff with an NVQ 2 or above. This is partially due to the loss of a greater number of staff than was anticipated and the delays in commencing training programmes for this. During the day of the inspection visit the companys new training coordinator was visiting the home to assess the training needs staff may have and was able to provide some information about proposed changes in how training is delivered in the future. Staff did express their interest in further NVQ training but felt the progress to do this was extremely slow. The training information available did support that the key topics of health and safety were included and provided on a regular basis. Some staff have had training in other topics such as dementia awareness, pressure area care, and customer care. The home has two employees that are able to provide training for moving and handling to other staff. There are only a small number of the registered nurses working in the home with a Care Homes for Older People Page 24 of 30 Evidence: qualification in mental health. The Registered Manager was advised to look at how this effects the planning and delivery of specialist care that the people living with dementia and other mental health needs that they support may require. The sampled care planning records that were seen did not provide staff with sufficiently detailed instruction or assessment tools to manage any significant mental health needs that they may have. Care Homes for Older People Page 25 of 30 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The service is run in the best interests of the people living there, and is managed effectively by a knowledgeable manager and provider. Evidence: Comments in the returned surveys from staff showed that they felt supported by the manager of the home and that their relationship with her had improved. They expressed that they felt part of a team and that the enjoyed working in the home. Since the last inspection process the Deputy Manager and nursing lead post has become vacant. It was confirmed during the day that a new person has been appointed to the role and should be commencing in the home within the next few weeks. The Registered Manager has continued to look at enhancing her role and has undertaken some management training through the organisation by obtaining an Care Homes for Older People Page 26 of 30 Evidence: intermediate certificate for Supervising Health and Safety. We looked at the processes for quality assurance and the formal processes for consultation with residents and their relatives about their opinion of the services provided. They have some formal processes in place such as the periodical surveys to residents and relatives and have now got a regular programme of residents, relatives and staff meetings. The home has a system of safekeeping for personal monies for some of the residents living in the home. This process is monitored by the financial auditors of the company and also practices are checked as part of the routine visits by a representative of the provider organisation. As there were no previous concerns found at the last inspection process for this and there is a robust checking system in place this was not reviewed during this inspection visit. The frequency of formal supervisions of staff was seen to be variable at the last inspection, since then the programme has improved and they have stated to include observation of clinical practices, medication administration and annual appraisals. A small sample of the records for safe working practices were reviewed and it could be seen that safety checks on wheelchairs, water temperatures and emergency lighting are all carried out regularly by the maintenance staff. The addition of the new Check it system has assisted with highlighting and ensuring that these are carried out regularly. Information given by the Registered Manager in the AQAA shows that lifts, hoists and safety equipment is all serviced regularly. Care Homes for Older People Page 27 of 30 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 28 of 30 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations Care Homes for Older People Page 29 of 30 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). 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